Abstracts Were Included Where Articles Were Not Submitted

The 33rdConference on Priorities in Perinatal Care in South Africa was held under the auspices of the Priorities in Perinatal Care Association and sponsored by Abbott Laboratories SA (Pty) Ltd.

Editor’s Note:

The articles included in these Proceedings were, mostly, received electronically and have been included as submitted by the presenter/author. Faxed articles have been retyped.

Some articles have been shortened.

Abstracts were included where articles were not submitted.

Articles have not been included for presentations, which were withdrawn and not presented at Priorities.

Late submissions received after the Proceedings had been compiled and passwords allocated are included at the end of the Proceedings.

INDEX

AUDIT OF ANTENATAL CLINIC FIRST VISITS IN JOHANNESBURG 2013. E Buchmann1

COMPARISON OF GESTATIONAL AGE (GA) CALCULATED USING LAST NORMAL MENSTRUAL PERIOD (LNMP) VS ULTRASOUND IN WOMEN REQUESTING SECOND TOP AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL (CHBAH). DR BALOYI STEPHEN 5

DOES THE AVAILABILITY OF A MOBILE-CONNECTED UMBILICAL DOPPLER DEVICE (UMBIFLOW™) IN A PRIMARY CARE MATERNITY SETTING REDUCE REFERRALS TO SPECIALISED CARE? J Mufenda 9

AN ACCURATE SEMI-AUTOMATED OSCILLOMETRIC BLOOD PRESSURE DEVICE FOR USE IN PREGNANCY (INCLUDING PRE-ECLAMPSIA) IN A LOW- AND MIDDLE-INCOME COUNTRY POPULATION: THE MICROLIFE 3AS1-2. H Nathan 12

MICROCIRCULATION IN WOMEN WITH SEVERE PRE-ECLAMPSIA AND HELLP SYNDROME. Jérôme Cornette 17

A CLINICAL AUDIT OF ALL PRIMIGRAVIDAE WITH HYPERTENSIVE DISORDERS DELIVERING AT A REGIONAL HOSPITAL OVER A 1 YEAR PERIOD (MARCH 2012 – MARCH 2013). J Moodley 20

INDUCTION OF LABOUR WITH TITRATED MISOPROSTOL AT ≥38WEEKS IN WOMEN WITH A LIVE FOETUS AND INTACT MEMBRANES: A PROSPECTIVE STUDY. Dr Yasmin Adam 24

BARRIERS TO EARLY ANTENATAL BOOKING OF PREGNANT WOMEN IN SELECTED CLINICS OF A LEVEL I HOSPITAL IN ETHEKWINI DISTRICT. Dr Sisana Majeke 27

‘THEY DO NOT WANT TO TEST’—BARRIERS TO EARLY ANTENATAL CARE IN SOUTH AFRICA. D.N. Haddad 31

HEALTH CARE PERSONNEL’S KNOWLEDGE OF PREVENTION OF MOTHER-TO-CHILD-TRANSMISSION (PMTCT) OF HIV AT JOUBERTON COMMUNITY HEALTH CENTRE (DR KENNETH KAUNDA DISTRICT /NORTH WEST PROVINCE). J Kanku 38

ON-SITE ESMOE-EOST SATURATION TRAINING IN NKANGALA DISTRICT, MPUMALANGA: A PILOT STUDY. JD Makin 44

DEVELOPING EOST VIDEO CLIPS AND TESTING THEM AS A METHOD FOR IMPLEMENTING FIREDRILL TRAINING IN THE LABOURWARD: A PILOT STUDY. E Wethmar 49

CHILDBIRTH EDUCATION TRENDS IN THE PRIVATE SECTOR OF SOUTH AFRICA (ABSTRACT). Barbara Hanrahan 54

THE USE OF ACTION LEARNING AS A METHODOLOGY TO IMPROVE NEWBORN CARE IN KWAZULU-NATAL (ABSTRACT). D. Nyasulu 55

QUALITY INTRAPARTAL CARE, AS PERCEIVED BY WOMEN.

Tsweleng Louisa Mmakwena56

THE PRETERM BIRTH SYNDROME: APPLYING THE PHENOTYPIC PROTOTYPIC CLASSIFICATION IN A MIDDLE INCOME PUBLIC URBAN TERTIARY HOSPITAL.

Pattinson RC60

SURVIVAL OF VERY LOW – BIRTH- WEIGHT INFANTS ACCORDING TO BIRTH WEIGHT AND GESTATIONAL AGE AT A SEMI-RURAL HOSPITAL. (LURWMH). N. Kapongo 63

SOME OUTCOMES FOLLOWING 10 YEARS OF THE LIMPOPO INITIATIVE FOR NEWBORN CARE (LINC) IN SEKHUKUNE DISTRICT. DH Greenfield 79

'IMPLEMENTING INTER FACILITY, AMBULANCE KMC. CHANGING ATTITUDES, SAVING LIVES IN SOUTH AFRICA (ABSTRACT). V Booysen 83

DO EDUCATIONAL DOCUMENTARIES ON DONOR BREASTMILK INFLUENCE MOTHERS’ BELIEFS ABOUT THE ACT OF DONATING THEIR BREASTMILK?: EXPERIENCES IN A KANGAROO MOTHER CARE UNIT IN SOUTH AFRICA. E Brierley 84

AN OVERVIEW OF KANGAROO MOTHER CARE ON NEONATAL GROWTH IN PRETERM INFANTS IN PELONOMI HOSPITAL, BLOEMFONTEIN. DR ML MAMABOLO 90

ARE MATERNITY WAITING HOMES (MWH) RELEVANT AND COST EFFECTIVE IN THE DELIVERY OF PERINATAL HEALTHCARE SERVICES TO REDUCE PERINATAL MORBIDITY/ MORTALITY IN SOUTH AFRICA? A CRITICAL REVIEW (ABSTRACT).

Dr Donald HA Amoko94

BEST PRACTICE GUIDELINE DEVELOPMENT – WHAT DOES IT MEAN AND HOW IS IT DEVELOPED? (ABSTRACT). Dr Welma Lubbe 95

DOES TECHNOLOGY ONLY MEAN MACHINES AND EQUIPMENT? - BPG GUIDELINES TO DIRECT NDSC AS MODEL OF CARE IN THE SA CONTEXT (ABSTRACT).

Dr Welma Lubbe96

WHERE AND WHY DO INFANTS DIE? Dr M Kunneke98

REDUCING MATERNAL AND PERINATAL DEATHS: A RANDOMISED CONTROL TRIAL STUDYING EFFECTS OF THE COPPER INTRAUTERINE DEVICE AND INJECTABLE PROGESTOGEN CONTRACEPTIVE ON DEPRESSION AND SEXUAL FUNCTIONING OF POSTPARTUM WOMEN IN THE EASTERN CAPE. Mandisa Singata 101

MATERNAL DEATHS AT CHRIS HANI BARAGWANATH, 1997-2012. EJ Buchmann106

THE IMPACT ON THE MATERNAL AND FETAL OUTCOMES OF LOWER RESPIRATORY TRACT INFECTIONS IN PREGNANCY (ABSTRACT). M Machetela 111

A CLINICAL AUDIT OF PROVIDER INITIATED HIV COUNSELLING AND TESTING IN A GYNAECOLOGICAL WARD OF A DISTRICT HOSPITAL,IN KWAZULU-NATAL, SOUTH AFRICA.

Bryan M112

THE INCIDENCE OF HIV SEROCONVERSION DURING PREGNANCY AT PELONOMI HOSPITAL ANTENATAL CLINIC (ABSTRACT). Kgasane T 118

A RANDOMISED COMPARATIVE TRIAL COMPARING THE EFFICACY OF INFANT PERI-EXPOSURE PROPHYLAXIS WITH LOPINAVIR/RITONAVIR (LPV/R) VERSUS LAMIVUDINE TO PREVENT HIV-1 TRANSMISSION BY BREASTFEEDING. THE ANRS 12174 PROMISE PEP TRIAL. Kim Harper 119

AVAILABILITY of HUMAN RESOURCES and INFRASTRUCTURE for EARLY INFANT DIAGNOSIS (EID): RESULTS from a NATIONAL SITUAUTION ASSESSMENT, 2010. Nobuntu Noveve 124

HAEMORRHAGE AT OR FOLLOWING CAESAREAN SECTION. Dr U Wessels128

UNECESSARY CAESAREAN SECTION: A MAJOR FACTOR CONTRIBUTING TO MATERNAL DEATHS FROM OBSTETRIC HAEMORRHAGE IN KZN. Neil F Moran 133

SAFETY VERSUS ACCESSIBILITY: A DILEMMA IN MATERNITY CARE IN SOUTH AFRICA (ABSTRACT). RC Pattinson 138

ON-SITE PRIMARY CARE MIDWIFE BIRTH UNIT: A NEW MODEL FOR SAFE PRIMARY CARE CHILDBIRTH. G Justus Hofmeyr 139

PRE- AND POST-TEST RESULTS AT ESMOE SATURATION TRAINING IN SIX PRIORITY DISTRICTS. E Buchmann 143

Scaling up of ESMOE in South Africa: What is it going to cost and what type of training are we going to use? (ABSTRACT). CM Bezuidenhout 147

THE IMPACT OF ONSITE ESMOE TRAINING ON CAESAREAN SECTION RATE AND COMPLICATIONS IN THREE DISTRICT HOSPITALS IN NKANGALA DISTRICT, MPUMALANGA PROVINCE SOUTH AFRICA (ABSTRACT). Dr Donald HA Amoko 149

A REALIST REVIEW OF PARTOGRAPH USE. Lavender T150

DELIVERY OF WOMEN WITH A PREVIOUS UNEXPLAINED INTRA-UTERINE FETAL DEATH AT TERM: A PROSPECTIVE COHORT STUDY AT TYGERBERG HOSPITAL, SOUTH AFRICA. L Oberholzer 151

A DECADE OF AVOIDABLE FACTORS; ARE WE TAKING SUFFICIENT HEED? Monica Engelbrecht 155

EARLY INFANT FEEDING PRACTICES IN HIV EXPOSED AND UNEXPOSED INFANTS: RESULTS FROM THE SOUTH AFRICAN PMTCT EVALUATIONS, 2010 AND 2011. Dudu Nsibande 160

Increased CONGENITAL CYTOMEGALOVIRUS Co-Infection with In Utero-Acquired HIV-Infection. GB Theron 166

BIRTH PREVALENCE OF CONGENITAL CMV (CCMV) IN HIV EXPOSED INFANTS IN SOUTH AFRICA. Dr AM van Niekerk 169

FEATURES OF TUBERCULOSIS (TB) EXPOSED NEONATES AND EFFECTIVENESS OF TB CHEMOPROPHYLAXIS USING RIFAMPICIN AND ISONIAZID AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL. KT Mathivha 177

NATIONAL BIRTH DEFECTS DATA: 2006-2012 (ABSTRACT). Vuyiswa Mtyongwe180

THE NUMBERS, CHARACTERISTICS AND OUTCOME OF TERM / NEAR-TERM INFANTS WITH INTRAPARTUM ASPHYXIA ADMITTED AT CHRIS HANI BARAGWANATH HOSPITAL .

E Bruckmann181

THE INFLUENCE OF BIRTH SITE ON SHORT-TERM OUTCOMES OF ENCEPHALOPATHIC NEWBORN INFANTS TREATED WITH THERAPEUTIC HYPOTHERMIA AT GROOTE SCHUUR HOSPITAL, CAPE TOWN, SOUTH AFRICA (ABSTRACT). Victoria Nakibuuka 185

MEDICO-LEGAL ISSUES WITH RESPECT TO INTRAUTERINE HYPOXIA (BIRTH ASPHYXIA).

Peter Cooper186

LEADERSHIP EFFECTIVENESS FOR MATERNAL, NEWBORN AND CHILD HEALTH (ABSTRACT). Voce AS 189

IS THERE A NEED FOR DEBRIEFING FOLLOWING CATASTROPHIC LABOUR WARD EVENTS?

K Frank190

PSYCHOSOCIAL IMPLICATIONS OF STILLBIRTH FOR THE MOTHER AND HER FAMILY: A CRISIS-SUPPORT APPROACH. Melanie Human 192

PATIENT CENTRED MATERNITY CARE. S Fawcus198

FETAL HEART RATE MONITORING: DOES IT COUNT? A Jagau202

THE EFFECTS OF ECONOMIC DISPARITY AND DEPRESSION DURING PREGNANCY ON MATERNAL PHYSIOLOY AND INFANT BIRTH WEIGHT (ABSTRACT). WP Fifer 207

AUDIT OF ANTENATAL CLINIC FIRST VISITS IN JOHANNESBURG 2013

E Buchmann, N Lembethe, M Makgotlhoe, M Maseleni

Johannesburg District Clinical Specialist Team

Introduction

Early first-visit pregnancy attendance (booking) at antenatal clinic offers opportunities for detection of problems that may affect pregnancy outcome, such as anaemia, hypertension and HIV. A national goal in South Africa is that at least 50% of women should attend antenatal clinic before 20 weeks’ gestation. Johannesburg district fall short of this goal, with only 38% of antenatal first visits occurring before 20 weeks’ gestation. This audit was done from August to October 2013 to understand the process of antenatal first visits in Johannesburg and to identify possible barriers to early antenatal booking.

Setting and methods

In Johannesburg, there are 118 public service antenatal clinics (82 municipal, 21 provincial at clinics, 10 provincial at community health centres (CHCs), and 5 at hospitals) in seven sub-districts. About 80 000 women book at antenatal clinics each year, just under half at municipal clinics. This audit was done by using random sample of 20 antenatal clinics, stratified by type of clinic (10 municipal clinics, 5 CHCs, and provincial clinics) and sub-district (all sub-districts represented, proportionate to size of population). Permission to undertake the audit was obtained from the management of the clinics. A midwife or doctor from the district clinical specialist team (DCST) visited each clinic and interviewed the midwife in charge of the antenatal clinic about how antenatal first visits are managed. Then, the DCST member interviewed a convenience sample of 16 women from the antenatal clinic queue, asking them questions about how and when they discovered they were pregnant and their experience with booking for antenatal care.

Results

Eleven of the 20 clinics, which included all 10 municipal clinics, had only one examination cubicle for antenatal care. Six antenatal clinics had 3 or more cubicles. Most antenatal clinics accepted first visits on only certain days of the week, with 8 (including 7 municipal clinics) setting aside only one day a week. Five antenatal clinics accepted first visits on all weekdays. None offered weekend antenatal care. Midwives at four of the clinics stated that they sometimes turned pregnant women away when attempted to initiate antenatal care. The staff allocated to antenatal care was 1 midwife in 5 antenatal clinics, 2 midwives in 5 antenatal clinics, and 3 or more midwives in 10 antenatal clinics. Nine of the antenatal clinics received no allocation of enrolled or assistant nurses. Regarding paperwork, the reported number of documents and forms required for antenatal first visit care varied from 1 to 9, with a median of 6. The most frequently required documents that had to be completed were the antenatal cared, the antenatal register, the FDC register, the daily statistics sheet, the blood tests book, the IPT book, the yellow file for ART, blood forms, and the BANC check-list.

Of the 320 pregnant women interviewed, at a median of 6 months’ gestationa, 35% were nulliparous. The median gestational age at which they said they found out they were pregnant was 2 months, at which they consulted a health care provider was 3 months, and at which they formally started antenatal care in a public facility was 4 months. The first health care provider consulted was a government clinic in 74% of women, a private medical practitioner in 24%, and a government hospital in 2%. Table 1 shows how the women discovered they were pregnant. One hundred and thirty women (41%) said they had been turned away from antenatal clinic when they tried to book. The reasons they were given are shown in Table 2.

The median number of months it took from finding out they were pregnant to completing the antenatal first visit was 2 (Figure 1). This delay had three components: 1) seeing a health provider after finding out they were pregnant (Figure 2); 2) attempting to book for antenatal care after seeing the health provider (Figure 3); and 3) actually starting antenatal care after attempting to do so (Figure 4). Of note was that taking 2 or more months to book after finding out about the pregnancy was associated with home pregnancy testing (62/93; 67%), as opposed to clinic pregnancy testing (44/106; 41%) (P<0.01).

Table 1How pregnant women found out that they were pregnant (n=319)

Clinic pregnancy test / 106 (33%)
Home pregnancy test / 105 (33%)
Knew without testing / 59 (19%)
Private practitioner pregnancy test / 22 (7%)
Private practitioner ultrasound / 21 (7%)
Other / 6 (2%)

Table 2Reasons women gave for being turned away when trying to book (n=317)

Figure 1Percentage of women starting antenatal care (y-axis) by number of months (x-axis) after finding out they were pregnant

Figure 2Percentage of women going to a health care provider for the first time in the pregnancy (y-axis) by number of months (x-axis) after finding out they were pregnant

Figure 3Percentage of women attempting to book for antenatal care (y-axis) by number of months (x-axis) after going to a health care provider for the first time

Figure 4Percentage of women actually receiving first-visit antenatal care (y-axis) by the number of months (x-axis) after attempting to book for antenatal care

Discussion

Municipal clinics are under-resourced for antenatal care and appear unable to provide a daily antenatal booking service. The greatest delays in booking for antenatal care appear to be from finding out about the pregnancy to seeing a health care provider (associated with home pregnancy confirmation), and from seeing a provider to making contact with the antenatal care system. These two delays involve the woman/community and the primary care system respectively. Innovations are needed to streamline the passage of women from pregnancy confirmation to starting antenatal care. One such innovation may be to provide pregnancy test kits to community health workers in the ward-based outreach teams.

COMPARISON OF GESTATIONAL AGE (GA) CALCULATED USING LAST NORMAL MENSTRUAL PERIOD (LNMP) VS ULTRASOUND IN WOMEN REQUESTING SECOND TOP AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL (CHBAH)

DR BALOYI STEPHEN- University of the Witwatersrand

Background and introduction

GA presents a platform for prenatal testing, preterm labour management, and timing of post-date induction of labour, technique of TOP, reduces IOL for post-date pregnancies and significantly reduces the total workload. Methods for calculating gestational age include Naegeles rule, pregnancy wheel - LNMP and ultrasound. In busy units, booking scans are not possible for all patients but are recommended for selected patients. Ultrasound GA calculation helps in determining whether TOP can be performed in a hospital or as an outpatient basis. Higher GA terminations are performed in the hospital in order to avoid or minimize the risk of haemorrhage. In South Africa, Obstetric haemorrhage is among the highest causes of maternal dearth (2012)

Aims and Objectives

To compare GA calculated using LNMP VS Ultrasound in women requesting second trimester abortion at CHBAH

Methods

Study setting-CHBAH in Soweto with a population size 640588 which makes 50.38% of the adult population

Study population-Women who were referred for second trimester abortion were recruited (>18years)

Exclusion criteria- Women above 20weeks gestation, those who had TOP due to medical conditions like Pre enclampsia and those who did not give consent

Study design and sampling

Main study: A prospective cohort study where women were recruited for 3 days a week. Procedures done includes history, examination and Ultrasound

Data collection

Data was collected from medical files and through interviews. Data was entered into Microsoft excel spread sheet and exported into STATA10 statistical tool for analysis

Ethics

Study was approved by HREC of the University of the Witwatersrand. Hospital permission was granted by the CHBAH medical advisory committee on behalf of the CEO. All participants provided written informed consent

Results

The number of women interviewed during the study period was 211. The mean age was 26.52(SD±6.38) and the range of 18-43. The median parity of women was 1 with the IQR 1-2 and the range of 0-6. Two hundred and five women (97.16%) had primary and secondary school education. Hundred and three women were using contraception at the time of conception. Hundred and eight did not. Fifty one (24.17%) women were found to be HIV positive and HIV status of 14(6.64%) women was unknown. The median CD4cell count was 500(IQR=350-560). The range was 45-913. Twenty three women (48.94%) of those who were HIV positive used antiretroviral therapy (ART)

Table 1Results

Fig 1 A Box and Whisker plot

Discussion

The Box and Whisker plot comparing GA calculated by two methods shows that the median was statistically significantly different and that there were more outliers when GA was calculated using dates and these could have surely have affected clinical management. The spearman rho was 0.38( p-0.00). There was no correlation between assessment of GA by dates and by sonar.

A study compared 2 Ultrasound protocols;

Group A- where routine early Ultrasound scans at 18-23 plus selective clinical indications were done.

And group B- where booking scans for all patients regardless of GA plus follow-ups for selective clinical indications were done.

Approximately 34% of patients benefited from the booking scans- there were reduced numbers of post dates pregnancies but at the same time increased the work loud significantly

A limitation of the study is that it may not be generalized to other regions of Gauteng and other provinces across SA. This population of women may be different from women who are planning pregnancy who may remember their dates

Conclusion

Gaby sonar is the most reliable way to effectively determine the GA early in pregnancy and should be offered to all women.

DOES THE AVAILABILITY OF A MOBILE-CONNECTED UMBILICAL DOPPLER DEVICE (UMBIFLOW™) IN A PRIMARY CARE MATERNITY SETTING REDUCE REFERRALS TO SPECIALISED CARE?

J Mufenda Department of Obstetrics and Gynaecology, Stellenbosch University and Tygerberg Hospital, South Africa